Vikas Verma
Delhi
Summary
Dynamic professional with over 16 years of experience in the healthcare industry, specializing in Fraud, Waste, and Abuse (FWAE) domain within the payer sector. Currently serving as Deputy Manager at Optum Global Solutions Pvt. Ltd. Proven expertise in developing analytic capabilities and healthcare core competencies across Medicare, Medicaid, and Commercial Lines of Business (LOB). Proficient in fraud detection analytics, report development, and creating dashboards using Power BI. Skilled in team management, client interaction, and data analysis. Holds a BPT from GGSIP University, Delhi, CFA/MFA from ICFAI University, and a Diploma in Data Science from IIT Madras. Proficient in SQL programming with working knowledge of Python, machine learning, data visualization, and database management.
Overview
17
17
years of professional experience
Work History
Deputy Manager
OPTUM GLOBAL SOLUTIONS PVT.LTD [UHG]
2018.02 - Current
- Currently working at Deputy Manager grade in Fraud, waste and abuse domain (primarily payment integrity domain) in building analytic capabilities
- Developing healthcare core capabilities in Prepay and Postpay across Medicare, Medicaid, and Commercial LOB.
- Perform fraud detection analytics, implement analytics solutions and developing reports for assigned projects, including use of SQL, Excel, and Power BI
- Strong working knowledge of US healthcare (Payer Domain) and claims analytics concepts
- Experience in creating dashboards using Power-BI, Bars, Lines, Pies, Maps, scatter plots, Tree map, Heat Map etc.
- Develop analytic rules for fraud detection by statistical/data driven approach, Peer analysis, hard deny (CMS guidelines), create BRD and present to leadership and client
- Developing clinical rules (like soft deny, hard deny) and statistical rules for fraud detection
- 9 years of strong business reporting, people management and team building experience
- Working knowledge of machine learning concepts like linear regression, classification, SVM, Decision-Tree, Bagging, Boosting, feature processing, pipeline, imputation, hyperparameter tuning, cross validation, model training, and libraries like Scikit-learn, XGBoost, Numpy, Pandas, regex, Seaborn, matplotlib.
Assistant Manager
OPTUM GLOBAL SOLUTIONS PVT.LTD [UHG]
2015.01 - 2018.02
- Supervised a team of 22 members in day-to-day operations to meet performance, quality and service expectations.
- Leading, mentoring & monitoring the performance of team (Excel Dashboards,Performance dashboard).
- Completed and monitored quality improvement project that lead to overall process accuracy improvement from 91% to 99% for Noida and Hyderabad sites.
- Leading client call to discuss process requirements, progress updates, and address any concerns or queries.
Sr. Clinical Investigator
OPTUM GLOBAL SOLUTIONS PVT.LTD [UHG]
2012.09 - 2015.01
- Joined as Sr. Clinical Investigator in Fraud, Waste abuse and Error (FWAE), E&I LOB process (payment integrity)
- Knowledge of CPT/HCPCS, modifiers, and ICD
- Mentoring and training new hires
- Excel Dashboards
- Data analysis for outlier detection.
Clinical Resource
EXL services India PVT. LTD.
2010.02 - 2012.08
- Clinical Resource for analysis and summarization of medical record for attorneys to contest claim
- Helped team in achieving quality score by doing in-process-review.
Analyst
WNS
2008.12 - 2010.02
- Analyst for making discharge summary of cancer patients which is used by hospitals and insurance companies.
Process Associate
GENPACT
2007.01 - 2008.11
- Process Associate for Medical Underwriting process for long-term care Insurance
- Working with Underwriting Team and helping the underwriters for LTC Medical Insurance in taking decision
- Saved 4400 min/month of the process by generating and implementing the lean idea.
Education
Diploma in Data Science - Data Science
IIT Madras
IIT Madras09.2023
CFA/MFA - Finance
ICFAI University
Distance Education01.2012
BPT - Physiotherapy
GGSIP University
DIRD, Delhi06.2007
Skills
- Data Analysis: Exploratory Data Analysis (EDA)
- Statistical Analysis
- Database Management: SQL
- PowerBI
- Working knowledge of Python (NumPy, Pandas, scikit-learn, matplotlib),Data Visualization: Matplotlib, Seaborn, Machine Learning: Regression, Classification, Clustering
Timeline
Deputy Manager
OPTUM GLOBAL SOLUTIONS PVT.LTD [UHG]
2018.02 - Current
Assistant Manager
OPTUM GLOBAL SOLUTIONS PVT.LTD [UHG]
2015.01 - 2018.02
Sr. Clinical Investigator
OPTUM GLOBAL SOLUTIONS PVT.LTD [UHG]
2012.09 - 2015.01
Clinical Resource
EXL services India PVT. LTD.
2010.02 - 2012.08
Analyst
WNS
2008.12 - 2010.02
Process Associate
GENPACT
2007.01 - 2008.11
Diploma in Data Science - Data Science
IIT Madras
CFA/MFA - Finance
ICFAI University
BPT - Physiotherapy
GGSIP University
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